Provider Demographics
NPI:1033408778
Name:JONES, JUDITH ANN (CADC-1)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:CADC-1
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 CAPALINA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1288
Mailing Address - Country:US
Mailing Address - Phone:760-744-2104
Mailing Address - Fax:760-744-1382
Practice Address - Street 1:1560 CAPALINA RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1288
Practice Address - Country:US
Practice Address - Phone:760-744-2104
Practice Address - Fax:760-744-1382
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37-14261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone